Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Heart Rhythm. 2013 Aug;10(8):1119-24. doi: 10.1016/j.hrthm.2013.04.011. Epub 2013 Apr 10.
Conducting channels within scars form the substrate for infarct-related ventricular tachycardia (VT) and are targeted during catheter ablation. Whether the amount of left ventricular scar (LVS) affects outcomes after VT ablation is not known.
To test the hypothesis that increased LVS is associated with worsened clinical outcomes and reduced survival after VT ablation.
Patients with coronary artery disease and intrinsic AV nodal conduction undergoing infarct-related VT ablation were studied. A validated 32-point scoring system was used to measure LVS from 12-lead ECGs. Primary endpoint was all-cause mortality or transplantation. Secondary endpoint was a composite of death, transplantation, or readmission due to VT recurrence within 1 year of discharge.
Of 356 patients undergoing 466 infarct-related VT ablations screened, 192 (84% male, age 66 ± 11 years, 52% prior coronary artery bypass graft, ejection fraction 28% ± 11%) who underwent 245 procedures for VT (2.4 ± 1.5 VTs per patient, 31% with VT storm, refractory to 2.7 ± 1.2 antiarrhythmic drugs) between 1999 and 2009 were included. During mapping, all patients had low-voltage areas. Mean LVS was 21.4% ± 15.0%. Over 3.4 ± 3.1 years, 78 patients (41%) reached the primary endpoint (73 deaths, 5 transplants). In the first year after discharge, the secondary endpoint was reached in 56 subjects (29%). In a multivariate model, larger LVS (hazard ratio [HR] 1.03 for every 3% increase in LVS, P < .01), renal dysfunction (HR 2.66, P <.01), and increased age (HR 1.05 per year, P < .01) predicted mortality, whereas noninducibility of any VT was protective. (HR 0.36, P < .01) Larger LVS and renal dysfunction were associated with worsened 1-year outcomes, whereas noninducibility was protective.
LVS burden derived from 12-lead ECGs is a significant and independent predictor of mortality and clinical outcomes in subjects with infarct-related VT.
疤痕内的传导通道构成了与梗塞相关的室性心动过速（VT）的基质，并在导管消融中作为靶点。左心室疤痕（LVS）的数量是否会影响 VT 消融后的结果尚不清楚。
检验假设，即 LVS 增加与 VT 消融后临床结局恶化和生存率降低有关。
研究了患有冠状动脉疾病和固有房室结传导的患者，这些患者正在进行与梗塞相关的 VT 消融。使用经过验证的 32 分评分系统从 12 导联心电图测量 LVS。主要终点是全因死亡率或移植。次要终点是出院后 1 年内因 VT 复发而导致死亡、移植或再次入院的复合终点。
在筛选的 356 例接受 466 次与梗塞相关的 VT 消融的患者中，有 192 例（84%为男性，年龄 66±11 岁，52%有冠状动脉旁路移植术病史，射血分数 28%±11%）在 1999 年至 2009 年间进行了 245 次 VT 消融（每个患者消融 2.4±1.5 次 VT，31%为 VT 风暴，对 2.7±1.2 种抗心律失常药物耐药）。在标测过程中，所有患者均存在低电压区。平均 LVS 为 21.4%±15.0%。在 3.4±3.1 年的随访期间，有 78 例患者（41%）达到了主要终点（73 例死亡，5 例移植）。出院后第一年，56 例患者（29%）达到了次要终点。在多变量模型中，较大的 LVS（LVS 每增加 3%，风险比 [HR] 为 1.03，P<.01）、肾功能不全（HR 2.66，P<.01）和年龄增加（每年 HR 增加 1.05，P<.01）预测死亡率，而非任何 VT 的可诱发性具有保护作用（HR 0.36，P<.01）。较大的 LVS 和肾功能不全与 1 年预后恶化相关，而非可诱发性具有保护作用。
从 12 导联心电图获得的 LVS 负荷是与梗塞相关的 VT 患者死亡率和临床结局的重要且独立的预测因素。
